Provider Demographics
NPI:1780301796
Name:ZUK, BENJAMIN J
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:ZUK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2437
Mailing Address - Country:US
Mailing Address - Phone:660-785-1834
Mailing Address - Fax:
Practice Address - Street 1:502 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2437
Practice Address - Country:US
Practice Address - Phone:660-785-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-21
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist